183: Iranian Traditional Medicine and Evidence-based Medicine: an Overview of Dialogue between Two Paradigms

Background and aims: The history of medicine has experienced multiple emersions and wanes of several paradigms. Attenuation of a paradigm and finally its wane will occur when that paradigm is unresponsive to new scientific questions and needs. All studies run about Iranian Traditional Medicine (ITM) has acknowledged its ability to response to new clinical needs, but are in agreement in this point that instructions of ITM should be revised befitting to the Evidence-Based Medicine (EBM). This review describes the main dimensions of both ITM and EBM and criticizes the approach of adaptation of ITM instructions to principles of EBM. Methods: The keywords of Evidence–based Medicine, Traditional Medicine and Iran were searched through databases of Pub Med, CINAHL, and Google scholar. Also philosophical debates about medical paradigms were extracted from the Literature. Results: Experts in philosophy of medicine believe that two competing paradigms are typically incommensurable i.e. without a common Language into which both can be translated, and mutually exclusive because of their incompatible characteristics. ITM is both comparable and compatible with EBM, but cannot be completely integrated in EBM framework. Reiteration of experiences, exclusive value of expert opinions and practices and regarding to the art dimension of medical practice are the main characteristics of traditional paradigm. ITM gives credit for repeatability of experiences and opinions which have no place in EBM. Also, ITM emphasizes on expert opinions which are in the lowest level of EBM’s hierarchy of evidence. Conversely translating general knowledge into particular cases, as an index of art dimension of ITM is in contrast to scientific dimension of EBM that has challenges associated with applying the results of Randomized Controlled Trials to individual patients. Also epistemological and ethical critiques of EBM declined its predilection to other paradigms in which focus on unsystematic clinical observations, mechanistic reasoning and expert opinions. Conclusion: ITM, similarly to other paradigms, has distinct and noticeable characteristics and should be outreached internally. Although the rules of other paradigms may inhibit its ongoing evolution, but are disable to destruct its structure completely.